Influenza-Focus on Diabetic Patients
People with diabetes are more susceptible to infection
Key mechanisms associated with infection risk in diabetes:1
![](/dam/jcr:927ea9b0-8813-4057-8219-3199fcc5b765/diabetes.png)
Figure adapted from Casqueiro J, et al. 2012.1
Abbreviations
GIT, gastrointestinal tract; PMN, polymorphonuclear leukocyte.
People with diabetes experience more serious outcomes following influenza infection
- 3-6x risk of hospitalization2,4*
- 4x risk of ICU admission following hospitalization2*
- 4x risk of death from pneumonia3*
- 6x risk of death5*
Abbreviation
ICU, intensive care unit
Influenza vaccination was associated with hospitalization rates reduction for CV outcomes in people with type 2 diabetes6
Retrospective cohort analysis of the effectiveness of influenza vaccination in people with type 2 diabetes in England over a 7 year period (N=124,503).
- 22% hospitalization for heart failure (IRR 0.78, 95% CI 0.65–0.92)*1
- 30% hospitalization for stroke (IRR 0.70, 95% CI 0.53–0.91)*1
- 19% hospitalization for acute MI (IRR 0.81, 95% CI 0.62–1.04)*1
†Retrospective cohort analysis of the effectiveness of influenza vaccination in people with T2DM in England over a 7 year period (N=124,503).1 *vs unvaccinated people with diabetes.
Abbreviations
CI, confidence interval; CV, cardiovascular; CVD, cardiovascular disease; HR, hazard ratio; IRR, incidence rate ratio; MI, myocardial infarction; T2DM,
Influenza Vaccination is Associated with Reduced Cardiovascular Mortality in Adults with all Types of Diabetes
Danish nationwide cohort study in 241,551 patients, during 9 consecutive influenza seasons (2007-2016)7
![](/dam/jcr:cc3de612-83ef-431e-8efa-f31d85c4e113/hazard-ratio.png)
Forest plot of the association between influenza vaccination and risk of death when considering all seasons included in the study. The error bars represent 95% CIs. HRs were derived from multivariable Cox regression models with patient-level cluster variances and stratified on season year.
“Influenza vaccination is significantly associated with reduced risks of all-cause, cardiovascular, and stroke/AMI death despite rigorous control for confounding factors”
- 22% hospitalization for heart failure (IRR 0.78, 95% CI 0.65–0.92)*1
- 30% hospitalization for stroke (IRR 0.70, 95% CI 0.53–0.91)*1
- 19% hospitalization for acute MI (IRR 0.81, 95% CI 0.62–1.04)*1
†Retrospective cohort analysis of the effectiveness of influenza vaccination in people with T2DM in England over a 7 year period (N=124,503).1 *vs unvaccinated people with diabetes.
Abbreviations
CI, confidence interval; CV, cardiovascular; CVD, cardiovascular disease; HR, hazard ratio; IRR, incidence rate ratio; MI, myocardial infarction; T2DM,
Influenza Vaccination is Associated with Reduced Cardiovascular Mortality in Adults with all Types of Diabetes
Danish nationwide cohort study in 241,551 patients, during 9 consecutive influenza seasons (2007-2016)7
![](/dam/jcr:9eaf080c-7bef-4873-8876-bb65bc6f1083/hazard-ratio%20(1).png)
Forest plot of the association between influenza vaccination and risk of death when considering all seasons included in the study. The error bars represent 95% CIs. HRs were derived from multivariable Cox regression models with patient-level cluster variances and stratified on season year.
“Influenza vaccination is significantly associated with reduced risks of all-cause, cardiovascular, and stroke/AMI death despite rigorous control for confounding factors”
- 17% of all-cause death
- 16% of cardiovascular death
- 15% of death from AMI or stroke
- 11% of being admitted to hospital with acute complications associated with diabetes*
*diabetic ketoacidosis, hypoglycemia, or coma
Influenza vaccination in diabetes is a well-established recommendation8-10
Annual influenza vaccination is recommended for people with diabetes by health authorities and associations worldwide8
![](/dam/jcr:d7a19cb8-71ea-4836-a06e-2accb6861d30/Asset%209@2x.png)
The WHO recommends increasing influenza coverage of all people at high risk (including persons with diabetes)8
Abbreviation
WHO, World Health Organization.
Influenza vaccination rates remain sub-optimal worldwide11-15
In most countries there are no data on vaccine coverage rate for people with diabetes
![](/dam/jcr:cab62dc1-dd18-4058-be5b-09559d7e4d73/influenza-vaccination.png)
- Diabetes is on therise and globally 1 in 11 adults has diabetes16
- Datashow that influenzais an aggravating factor for diabetes people
- Influenza vaccination was associated witha reduction in the rate of hospital admissionsand deaths19,21
- Influenza vaccination is recommended(and funded) for people withdiabetes
![](/.imaging/webp/sanofi-templates/w1080/dam/campus-sanofi-om/articles/risk.png4/jcr:content/risk.png)
Despite these risks, influenza vaccines are underutilized in populations with diabetes20
- 3 times more risk ofhospitalizations17
- 6 times more risk ofdeaths18
compared to non-diabetics population - 30% for stroke19
- 22% for heart failure19
- 15% for pneumonia/influenza19
- 15%for cardiovascular deaths 21
- Up to 24% on all-cause death 19, 21
References
- Casqueiro J, et al. Indian J Endocrinol Metab. 2012.
- Allard R, et al. Diabetes Care. 2010; 33:1491–3.
- Valdez R, et al. Am J Public Health. 1999; 89: 1715–21.
- BouterKP, Diabetes Res Clin Pract1991;12:61-8.
- https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19(p4)accessed date December 2019
- VamosEP, et al. Can Med Assoc J. 2016; 188: E342–51
- Modinet al. DiabetesCare. 2020 Sep;43(9):2226-2233
- http://www.who.int/wer/2012/wer8747.pdf?ua=1
- https://idf.org/our-network/regions-members/europe/europe-news/290-people-living-with-diabetes-should-be-prioritised-for-a-covid-19-vaccine.html
- https://www.ecdc.europa.eu/sites/default/files/documents/seasonal-influenza-antiviral-use-2018.pdf
- Hung et al , Vaccine.2020 Sep 29;38(42):6545-655
- Tacken, Vaccine 2015; 33(38):4886-91.
- O'Halloran, Am 3. J PrevMed 2016; 50(1):e15-26.
- Yang, Infect Chemother 2015; 47(1):41-8.
- Yu, Hum VaccinImmunother2014; 10(4):1028-35
- International Diabetes Federation.IDF Diabetes Atlas, 9th edn.Brussels, Belgium: 2019. Available at:http://www.diabetesatlas.org
- Allard R, et al. Diabetes Care. 2010; 33:1491–
- https://www.gov.uk/government/publications/influenza-the-green-book-chapter-19(p4)accessed date December 2019.
- VamosEP, et al. Can Med Assoc J. 2016; 188: E342–51.
- NFID,Call to Action: The Dangers of Influenza and Benefits of Vaccination in Adults with Chronic Health Conditions. 2018.
- Modinet al. Diabetes Care. 2020 Sep;43(9):2226-2233